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Abstract
Objective. Ambulance diversion has been proposed as a solution to emergency department overcrowding andwaiting room deaths. For ethical andlegal reasons, it remains highly controversial. The impact on EMS resources is not known. This study seeks to determine how diversion impacts the availability of ambulance resources, specifically transport time, hospital turnaround, andtotal out-of-service time. Methods. All emergency ambulance responses in 2002 while one of the city's hospitals was on diversion were collected, including those responses during the hour of the diversion and30 minutes before andafter. The time intervals for these responses were time anddate matched to 2001, if no hospital was on diversion. Total out-of-service time (911 to availability for another call), time from departure from scene to arrival at hospital (transport interval), andtime from arrival at hospital to availability for another call (turnaround time) were compared by using a t-test. Results. The 1,563 instances of diversion were included, with 1,403 controls. Interim analysis allowed calculation of a sample size of 1,049 in each group to show a 2-minute difference in turnaround time and330 calls in each for a 5-minute difference in total out-of-service time (0.25 SD). Transport, hospital turnaround, andtotal out-of-service times were not different between diversion andcontrol time periods. This relies on the accuracy of the status button system andmay not generalize to systems with different geography, diversion policy, number of hospitals, or handling of interfacility transfers. Conclusion. The availability of EMS resources is maintained during times of ambulance diversion. Diversion avoids potential delays associated with sending ambulances to overwhelmed emergency departments.